From the Guidelines
Diabetic foot wounds (Diabetic Foot Ulcers) are classified using the SINBAD (Site, Ischaemia, Bacterial infection, Area and Depth) system or the WIfI (Wound, Ischaemia, foot Infection) system.
Classification Systems
- The SINBAD system is recommended for communication among healthcare professionals, as it provides a simple and straightforward way to describe the individual variables that compose the system 1.
- The WIfI system is an alternative option, which can be used when the required equipment and level of expertise is available, and it is considered feasible 1.
Specific Classification
- For characterising a person with an infected ulcer, the IDSA/IWGDF classification is recommended as the first option, or the WIfI system as an alternative option 1.
- The IDSA/IWGDF classification consists of four grades of diabetic foot infection and is used to identify which patients require hospital admission 1.
Clinical Utility
- The classification systems are intended to classify the severity of infection in people with diabetes and an ulcer of the foot, and to predict clinical outcomes and health resource use 1.
- The WIfI system is considered to have a direct link to clinical management, making it a favorable option when resources and clinical expertise are available 1.
From the Research
Classification Systems for Diabetic Foot Ulcers
The classification of diabetic foot ulcers is crucial for directing appropriate therapy and predicting outcomes. Several systems have been proposed, including:
- The SINBAD system, which includes Site, Ischaemia, Neuropathy, Bacterial Infection, and Depth, recommended for communication among health professionals 2
- The PEDIS system, which classifies ulcers according to perfusion, extent/size, depth/tissue loss, infection, and sensation, developed for research purposes 3
- The WIfI (Wound, Ischemia, and foot Infection) system, recommended for the assessment of perfusion and the likely benefit of revascularisation 2
- The IDSA/IWGDF (Infectious Diseases Society of America/International Working Group on the Diabetic Foot) classification, recommended for the assessment of infection 2
Key Factors in Classification
The classification systems consider various key factors, including:
- Patient-related factors, such as end-stage renal failure
- Limb-related factors, such as peripheral artery disease and loss of protective sensation
- Ulcer-related factors, such as area, depth, site, single or multiple ulcers, and infection 2
Importance of Classification
Accurate classification of diabetic foot ulcers is essential for providing appropriate wound care and therapeutic interventions, and for predicting outcomes 4, 5, 6. A clear and descriptive classification system can improve communication among healthcare professionals, leading to a less complex and more predictable treatment course, and ultimately, an improved result 5, 6.